Today I am launching a series of posts on how to read medical literature critically. The series should provide a solid foundation for this task and dove-tail nicely with some of the more dense themes that occur on this blog. Who should read the series? Everyone. Although the current model of dissemination of medical information relies on a layer of translators (journalists and clinicians), it is my belief that every educated patient must at the very least understand how these interpreters of medical knowledge (should) examine it to arrive at the information imparted to the public.
At the same time, both journalists and clinicians may benefit from this refresher. Finally, my own pet project is to get to a better place with peer reviews — you know how variable the quality of those can be from my previous posts. So, I particularly encourage new peer reviewers for clinical journals to read this series.
First, a conflict of interest statement. What comes first — the chicken or the egg? What comes first — expertise in something or a company hiring you to develop a product?
Well, in my case I would like to think that it was the expertise that came first and that Pfizer asked me to develop this content based on what I know, not on the fact that they funded the effort. At any rate, this is my disclaimer: I developed this presentation about three years ago with (modest) funding from Pfizer, and they had it on a web site intended for physician access. Does this mere fact invalidate what I have to say? I don’t think so, but you be the judge.
Roughly, the series will examine how to evaluate the following components of any study:
1. Study question
2. Study design
3. Study analyses
4. Study results
5. Study reporting
6. Study conclusions
I am not trying to give you a comprehensive course on how all of this is done, but merely make the reader aware of what entails a critical review of a paper.
Marya Zilberberg, MD, MPH,is the Founder and President of EviMed Research Group, LLC, a consultancy specializing in epidemiology, health services and outcomes research. She is also a professor of Epidemiology at the University of Massachusetts, Amherst and blogs at Healthcare, etc.
For an example of the damage caused when medical literature is not read critically, I suggest you examine http://retinopathyofprematurity.org/01summary.htm
Steve, I appreciate your suggestions.
And Peter, thanks for the additional links.
These are good sources (but always keen to learn of others):
“How to read a paper” Patricia Greenhalgh 2nd Edition BMJ Books 2001
Evidence Based Medicine: How to Practice and Teach EBM. E. Coiera 2nd edition McGraw Hill http://www.mieur.nl/mihandbook/r_3_3/handbook/home.htm
There is a generic health research listing here too:
Best wishes for 2011.
Hodges’ Health Career – Care Domains – Model
h2cm: help2Cmore – help-2-listen – help-2-care
There is certainly a lot of controversy about conflict of interest, and I appreciate your desire to bend over backwards to disclose your financial association with Pfizer. But it should only be mentioned in three settings: 1. when you are discussing a commercial product of Pfizer’s, 2. when you are discussing a product that competes with Pfizer, or 3. when you are advocating changes in regulations that might affect Pfizer. To mention it in other settings merely adds to the noise and confusion over the issue.